The Effect of Administering a Boundary Course to Third-Year Medical Students During Their Psychiatry Clerkship

Due to lack of experience, third-year medical students (MS3) may be vulnerable to boundary violations. Investigators aimed to increase awareness regarding boundary issues among MS3s and assess the effect of using videotaped scenarios and case-based discussion on medical students' comfort in managing boundary issues.

A nine-question pre-course survey was administered to MS3s enrolled at Cooper Medical School of Rowan University that asked students to rate their comfort in managing various boundary challenges. MS3s then viewed seven pre-recorded boundary-related cases followed by a 10-15-min discussion after each case. A post-course survey reassessed comfort in managing boundary challenges using the same nine questions, with three additional questions assessing satisfaction with the course. Change in pre- and post-course scores were analyzed using paired t tests and effect sizes. Internal consistency was assessed using Cronbach's alpha.

There was a significant difference between pre- and post-course total scores as well as seven of the nine individual scores. Effect sizes were large (d > .08). These findings indicate that students became more comfortable managing boundary issues following the course. In addition, satisfaction ratings were high indicating the course was perceived favorably.

Medical students perceived the course to be beneficial and reported that it increased their awareness of boundary issues. A boundary course at the beginning of the psychiatry clerkship can improve MS3s' comfort in managing boundary challenges. With increased comfort in managing boundary, students can better focus on other aspects of their psychiatry education and on building therapeutic alliances with their patients.